Yes I realize I am a bit late starting a thread about Veterans' Day, however it has been a busy week. But there is something that I feel needs to be recognized about this year's Veterans' Day that from what I can tell was completely overlooked in this year's commemoration activities and news reports. This was the first year when there was no World War I veteran alive on Veterans' Day. The last documented living World War I veteran, Florence Green who had served as an officer's mess steward in the British Royal Air Force at the end of WWI, died on February 4 of this year.

Veterans' Day was originally called Armistice Day when the recognition was started in 1919, to commemorate the November 11 armistice that suspended the hostilities of World War I, so not having a veteran of that war alive this Veterans' Day, not to mention the passing of that generation of veterans, is significant.

This is a group of veterans that I think has gotten too little recognition, as WWI has become almost a forgotten war. Fortunately a 15 year project in Britain collected interviews with some surviving WWI veterans in the 1990s and 2000s, resulting in a fascinating video released in 2008, "The Last Voices of WWI: A Generation Lost", that mixes the interviews with original footage and some re-created scenes. I purchased a copy a couple years ago and coincidentally have gotten to use parts of it while subbing a history class at the college this week. Hearing these veterans talk firsthand about their experiences including why they signed up, what the training was like, what the combat was like, etc, informs the students on those aspects in ways my lectures and the textbook simply cannot.

While Veterans' Day may be past, take a moment to think about the passing of this generation of veterans. They may not have been given a label like "the greatest generation", but what they accomplished was by no means shabby either.

This was the war that came to an end mostly because of The Great Influenza. By accident and not by intent, an H1N1 virus that originated in a pig farm in Kansas was the germ warfare weapon that killed 20 to 40 million people worldwide. By the time our troops went over there and spread it, there weren't many soldiers left to continue what had been deadlocked trench warfare in Europe.

For what it's worth, that's the same H1N1 virus that recently has reappeared in the last 4 years. It's been in the seasonal vaccine for the last 3 years. This newer strain doesn't kill as many, but it's still nasty.

This year's flu vaccine also has B Yamagata (new) and a new variant of H3N2.

Make sure you get your flu shot. For research purposes, I've already gotten two. Given the reaction of my lymph nodes to the second shot, I can attest that it works.

The final part of the 1918 pandemic is that when the war ended all those soldiers from around the world who had been concentrated on the western front and exposed to H1N1 went back home and took the disease with them, that's what really helped transform it from a regional event to a worldwide event. It was a perfect storm from a medical geography standpoint. The global population in 1918 was around 1.9 billion people, 20-40 million deaths means that it killed ~2% of the global population. And I have seen estimates that as much as one-third of the global population may have been infected by the disease, even more exposed to it.

Bill, several years ago I read somewhere that part of why the current H1N1 outbreak has resulted in considerably less mortality this time around is that there is a kind of residual immunity in the global population due to the extent of the 1918 pandemic. I am not convinced of the idea of a population immunity passed from generation to generation, but what are your thoughts on it?

Ironically I am here because of the pandemic. My paternal grandfather's first wife and two of their children died of H1N1 (presumably at least) during the winter of 1918-1919. He later re-married, to my paternal grandmother. My maternal grandmother was born in 1918 and her mother also contracted the disease that winter, but fortunately survived.

Glenn wrote:Bill, several years ago I read somewhere that part of why the current H1N1 outbreak has resulted in considerably less mortality this time around is that there is a kind of residual immunity in the global population due to the extent of the 1918 pandemic. I am not convinced of the idea of a population immunity passed from generation to generation, but what are your thoughts on it?

Whoa there!!! You *totally* do not understand. So let's start from scratch.

Influenza is a series of viruses that live in man and beast. When not floating around in humans, it infects swine and poultry. These viruses mutate all the time, giving them renewed ability to infect their hosts.

The jump from beast to man usually doesn't "take." Every once in a while though it does, as it did on that pig farm in Kansas circa 1917. When it does, we have a brand new virus which is of great concern to organizations like the CDC, because you never really know what you're going to get.

Each strain of influenza has a unique level of virulence. Some are well tolerated by the majority of the population. Others do more harm, and can results in a significant number of hospital stays (from complications like pneumonia) and mortality.

Typically the risk by age of mortality from influenza follows a "U" graph pattern. The very young and the very old are at highest risk of mortality, while healthy adults in the primes of their lives are able to take the hit and get moving again in a week. The 1917 H1N1 was unique in that the risk by age plot was a "W" rather than a "U". Why? Because this virus caused the immune systems of its hosts to attack the lungs. The stronger the immune system, the stronger the attack. Thus strapping, healthy young males would go from healthy to cyanotic (turning blue-black) in a day or two, and perish from complete respiratory failure. When soldiers were training to go overseas for war in 1918, they were densely clustered and so gave ample opportunity for this virus to spread and further modify via random changes.

The infection was so widespread and so devastating that most folks born in my father's generation were likely eventually exposed to it. Consequently when a variant of H1N1 started appearing in 2008/2009 and making its way around the globe, there was no ready supply of elderly for it to spread in via nursing homes and hospitals. So back when it hit Virginia before a vaccine was available, my father with stage IV cancer was safe from it while my son contracted the disease and was sick for a week. The virus skipped me because I was one of a rare few who got "the swine flu vaccine" back in 1976. That vaccination program got canned shortly after it got started because the pandemic never happened and there was hype made over some cases of Guillain-Barr Syndrome. (The added risk that year was 1 in 100,000.) In any case, I was protected by vaccine, my father was protected by exposure a lifetime ago, and my son was vulnerable.

Jason Rees wrote:I'm mandated to get the Flu-Mist every year. I much prefer that to a shot, but then not everybody can get it.

The problem with Flu-Mist is that - unlike the intramuscular injection - it is an attenuated (weakened) *live* virus. It causes an infection so mild that normal, healthy people destroy the virus before it spreads within them. However since it is a live virus, you can actually spread it to others. Thus if you are a health care worker who works with immunocompromised patients, then it's a really bad idea for you to be getting vaccinated with a live virus.

Flu-Mist is indicated for patients 2-49 years old. Interestingly enough, people in the 50-64 age range are not on the list of folks who should be getting Flu-Mist. The issue isn't its danger so much as the fact that the vaccine just doesn't seem to work in this age group.

For adults, the intramuscular injection of a killed virus has a better vaccine effect than the attenuated live virus. The choice of an adult to get Flu-Mist over an IM injection is strictly "the weenie factor" (e.g. fear of needles).

For children, the exact opposite is true. The intranasal vaccine (Flu-Mist) prevents more cases of influenza than intramuscular injection. It also for some reason or another offers some protection against viruses that have genetically drifted from those in the vaccine. But the intranasal flu vaccine was more likely to cause incidents of wheezing in children 1 year and younger, and all children with a history of asthma.

Jason Rees wrote:most military are mandated the flu-mist unless there are other factors, like asthma.

And you won't be allowed to sign up for the military if you have bad asthma, so...

It works I supposed. By mandating everyone get it, they achieve "herd immunity." Even if it isn't the best alternative, they effectively halt the spread by making it difficult for the virus to find eligible hosts.

Bill Glasheen wrote:Whoa there!!! You *totally* do not understand. So let's start from scratch.

Interesting, I ask you about the legitimacy of something I read a while back but as I said I am skeptical of, and I get told I "totally do not understand" followed by info supporting my skepticism. You are correct, I totally do not understand the nature and tone of your replies sometimes! I am beginning to think you either need a vacation or a good workout.

But thanks for the info, some of it was new to me. I have not followed virology much since my undergrad biology degree in the 1980s, which was before info on the 1917-1919 outbreak became popular. But I remembered enough to be skeptical. My wife and I also received the swine flu vaccinations in 1976, so I guess we're protected from the current H1N1 outbreak.

Glenn wrote:I ask you about the legitimacy of something I read a while back but as I said I am skeptical of, and I get told I "totally do not understand" followed by info supporting my skepticism. You are correct, I totally do not understand the nature and tone of your replies sometimes! I am beginning to think you either need a vacation or a good workout.

You wrote this...

Glenn wrote:Bill, several years ago I read somewhere that part of why the current H1N1 outbreak has resulted in considerably less mortality this time around is that there is a kind of residual immunity in the global population due to the extent of the 1918 pandemic.

That statement is factually consistent with the truth. It doesn't tell the *whole* truth, but it's consistent with the truth.

Glenn wrote:I am not convinced of the idea of a population immunity passed from generation to generation, but what are your thoughts on it?

That does not follow from the first statement. It is a physiologic impossibility.

Ah, in that case I did not word my question well because it was the author of what I read who tied those two statements together by conceptualizing a residual immunity that can be passed from generation to generation to contribute to population immunity. It was that author's unity of those two statements that I was questioning, not a case of me inferring the second statement from the first. Unfortunately I forget where I read that, I came across it while I was researching info on the current H1N1 outbreak for my Medical Geography lecture and since I did not plan on using such a questionable hypothesis in my lecture I did not bother noting its source.

And yes, better, thank you...Kentucky might soften the course Virginian in you yet

Glenn wrote:It was that author's unity of those two statements that I was questioning, not a case of me inferring the second statement from the first. Unfortunately I forget where I read that, I came across it while I was researching info on the current H1N1 outbreak for my Medical Geography lecture and since I did not plan on using such a questionable hypothesis in my lecture I did not bother noting its source.

Good move.

To be fair... When a mother is nursing her infant, said infant gets the benefit of that mother's antibodies until the infant is weaned. But there weren't a lot of fertile women around in 2009-2012 who were exposed to the 1917-1918 H1N1 virus. So I think we can rule that out.